LUIZ PAULO KOWALSKI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina - Líder
51 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 51
- Implication of the New AJCC pT Classification of SCC of the Lip Comparing With Other Oral Subsites(2021) TOLEDO, Loic Monginet; OLIVEIRA, Adriana Santos de; PINHEIRO, Renan Aguera; LEITE, Ana Kober Nogueira; MELLO, Evandro Sobroza de; MOYSES, Raquel Ajub; KULCSAR, Marco Aurelio V.; DEDIVITIS, Rogerio Aparecido; KOWALSKI, Luiz Paulo; MATOS, Leandro LuongoObjective To determine the implication of the new AJCC staging system for pT classification in a cohort of patients with SCC of the lip mucosa and compare it to other oral cavity sites. Methods Retrospective cohort of 744 patients treated between 2002 and 2017, by the Head and Neck Surgery Department of the University of Sao Paulo. Results Of 95 lip patients, 42 had pT upstage (58.1% of pT1 to pT2-3 and 50% of pT2 to pT3). Similar DFS/OS observed for those pT1 maintained or upstaged to pT2-3, pT2 patients upstaged to pT3 presented worse OS (49.4% versus 92.3%, P = .032). The comparison between lip and other mouth topographies, denoted better prognosis for pT1-2, but not for pT3-4a. Lip tumors had lower DOI, rates of perineural/angiolymphatic invasion, nodal metastasis, recurrence, and death. Conclusion The inclusion of DOI to the new pT classification better stratifies patients with SCC of the lip mucosa upstaged to pT3 by assessing inferior OS. Level of Evidence 3 Laryngoscope, 2021
- Standardization for oncologic head and neck surgery(2021) RONEN, Ohad; ROBBINS, K. Thomas; BREE, Remco de; GUNTINAS-LICHIUS, Orlando; HARTL, Dana M.; HOMMA, Akihiro; KHAFIF, Avi; KOWALSKI, Luiz P.; LOPEZ, Fernando; MAKITIE, Antti A.; NG, Wai Tong; RINALDO, Alessandra; RODRIGO, Juan P.; SANABRIA, Alvaro; FERLITO, AlfioThe inherent variability in performing specific surgical procedures for head and neck cancer remains a barrier for accurately assessing treatment outcomes, particularly in clinical trials. While non-surgical modalities for cancer therapeutics have evolved to become far more uniform, there remains the challenge to standardize surgery. The purpose of this review is to identify the barriers in achieving uniformity and to highlight efforts by surgical groups to standardize selected operations and nomenclature. While further improvements in standardization will remain a challenge, we must encourage surgical groups to focus on strategies that provide such a level.
- Impacts of Environmental Factors on Head and Neck Cancer Pathogenesis and Progression(2021) MIRANDA-GALVIS, Marisol; LOVELESS, Reid; KOWALSKI, Luiz Paulo; TENG, YongEpidemiological and clinical studies over the past two decades have provided strong evidence that genetic elements interacting with environmental components can individually and collectively influence one's susceptibility to cancer. In addition to tumorigenic properties, numerous environmental factors, such as nutrition, chemical carcinogens, and tobacco/alcohol consumption, possess pro-invasive and pro-metastatic cancer features. In contrast to traditional cancer treatment, modern therapeutics not only take into account an individual's genetic makeup but also consider gene-environment interactions. The current review sharpens the focus by elaborating on the impact that environmental factors have on the pathogenesis and progression of head and neck cancer and the underlying molecular mechanisms involved. Recent advances, challenges, and future perspectives in this area of research are also discussed. Inhibiting key environmental drivers of tumor progression should yield survival benefits for patients at any stage of head and neck cancer.
- Update of Radiofrequency Ablation for Treating Benign and Malignant Thyroid Nodules. The Future Is Now(2021) TUFANO, Ralph P.; PACE-ASCIAK, Pia; RUSSELL, Jonathon O.; SUAREZ, Carlos; RANDOLPH, Gregory W.; LOPEZ, Fernando; SHAHA, Ashok R.; MAKITIE, Antti; RODRIGO, Juan P.; KOWALSKI, Luiz Paulo; ZAFEREO, Mark; ANGELOS, Peter; FERLITO, AlfioThermal and chemical ablation are minimally invasive procedures that avoid removal of the thyroid gland and target symptomatic nodules directly. Internationally, Radiofrequency ablation (RFA) is among one of the most widely used thermal ablative techniques, and is gaining traction in North America. Surgery remains the standard of care for most thyroid cancer, and in the right clinical setting, Active Surveillance (AS) can be a reasonable option for low risk disease. Minimally invasive techniques have emerged as an alternative option for patients deemed high risk for surgery, or for those patients who wish to receive a more active treatment approach compared to AS. Herein, we review the literature on the safety and efficacy of RFA for treating benign non-functioning thyroid nodules, autonomously functioning thyroid nodules, primary small low risk thyroid cancer (namely papillary thyroid cancer) as well as recurrent thyroid cancer.
- The pesticides use and the risk for head and neck cancer: A review of case-control studies(2021) LEONEL, Augusto Cesar Leal da Silva; BONAN, Roberta Ferreti; PINTO, Mariana Bitu Ramos; KOWALSKI, Luiz Paulo; PEREZ, Danyel Elias da CruzBackground: Tobacco, alcohol consumption, and HPV infection are the most common risk factors for head and neck cancer (HNC). Despite of this, recent evidences are growing on the association between long-term exposure to pesticides and the risk of chronic diseases, including different types of cancer. The present review evaluated in current literature evidence of an association between exposure to pesticides and the occurrence of HNCs. Material and Methods: A literature search of the case-control studies was conducted in the PubMed, Web of science and Cochrane databases. Methodological quality of each study was rated with the Scottish Intercollegiate Guidelines Network (SIGN 50) checklist. Results: One thousand and thirty-five studies were identified and twelve met all criteria and, therefore, considered for quality assessment and data extraction. According to SIGN 50 criteria, six studies received an overall high-quality. All the studies considered of high quality found a positive association between exposure to pesticides and different HNC sites, including larynx, pharynx and nasal cavity. In addition, the increased risk was associated with the frequency of exposure. Conclusions: Finally, improving pesticide users' awareness of their risks and proper handling, as well as adopting protective measures such as the use of personal protective equipment, appear to be effective in reducing human health damage.
- Tracheal and Cricotracheal Resection With End-to-End Anastomosis for Locally Advanced Thyroid Cancer: A Systematic Review of the Literature on 656 Patients(2021) PIAZZA, Cesare; LANCINI, Davide; TOMASONI, Michele; D'CRUZ, Anil; HARTL, Dana M.; KOWALSKI, Luiz P.; RANDOLPH, Gregory W.; RINALDO, Alessandra; SHAH, Jatin P.; SHAHA, Ashok R.; SIMO, Ricard; POORTEN, Vincent Vander; ZAFEREO, Mark; FERLITO, AlfioAirway involvement by advanced thyroid carcinoma (TC) constitutes a negative prognosticator, besides being a critical clinical issue since it represents one of the most frequent causes of death in locally advanced disease. It is generally agreed that, for appropriate laryngo-tracheal patterns of invasion, (crico-)tracheal resection and primary anastomosis [(C)TRA] is the preferred surgical technique in this clinical scenario. However, the results of long-term outcomes of (C)TRA are scarce in the literature, due to the rarity of such cases. The relative paucity of data prompts careful review of the available relevant series in order to critically evaluate this surgical technique from the oncologic and functional points of view. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement on the PubMed, Scopus, and Web of Science databases. English-language surgical series published between January 1985 and August 2021, reporting data on >= 5 patients treated for TC infiltrating the airway by (C)TRA were included. Oncologic outcomes, mortality, complications, and tracheotomy-dependency rates were assessed. Pooled proportion estimates were elaborated for each end-point. Thirty-seven studies were included, encompassing a total of 656 patients. Pooled risk of perioperative mortality was 2.0%. Surgical complications were reported in 27.0% of patients, with uni- or bilateral recurrent laryngeal nerve palsy being the most common. Permanent tracheotomy was required in 4.0% of patients. Oncologic outcomes varied among different series with 5- and 10-year overall survival rates ranging from 61% to 100% and 42.1% to 78.1%, respectively. Five- and 10-year disease specific survival rates ranged from 75.8% to 90% and 54.5% to 62.9%, respectively. Therefore, locally advanced TC with airway invasion treated with (C)TRA provides acceptable oncologic outcomes associated with a low permanent tracheotomy rate. The reported incidence of complications, however, indicates the need for judicious patient selection, meticulous surgical technique, and careful postoperative management.
- Immediate Intraoperative Repair of the Recurrent Laryngeal Nerve in Thyroid Surgery(2021) SIMO, Ricard; NIXON, Iain J.; ROVIRA, Aleix; POORTEN, Vincent Vander; SANABRIA, Alvaro; ZAFEREO, Mark; HARTL, Dana M.; KOWALSKI, Luiz P.; RANDOLPH, Gregory W.; KAMANI, Dipti; SHAHA, Ashok R.; SHAH, Jatin; MARIE, Jean-Paul; RINALDO, Alessandra; FERLITO, AlfioObjectives Recurrent laryngeal nerve (RLN) injury is a recognized risk during thyroid and parathyroid surgery and can result in significant morbidity. The aim of this review paper is to consider the optimal approach to the immediate intraoperative repair of the RLN during thyroid surgery. Methods A PubMed literature search was performed from inception to June 2020 using the following search strategy: immediate repair or repair recurrent laryngeal nerve, repair or reinnervation recurrent laryngeal nerve and immediate neurorraphy or neurorraphy recurrent laryngeal nerve. Results Methods of immediate intraoperative repair of the RLN include direct end-to-end anastomosis, free nerve graft anastomosis, ansa cervicalis to RLN anastomosis, vagus to RLN anastomosis, and primary interposition graft. Techniques of nerve repair include micro-suturing, use of fibrin glue, and nerve grafting. Direct micro-suture is preferable when the defect can be repaired without tension. Fibrin glue has also been proposed for nerve repair but has been criticized for its toxicity, excessive slow reabsorption, and the risk of inflammatory reaction in the peripheral tissues. When the proximal stump of the RLN cannot be used, grafting could be done using transverse cervical nerve, supraclavicular nerve, vagus nerve, or ansa cervicalis. Conclusions Current evidence is low-level; however, it suggests that when the RLN has been severed, avulsed, or sacrificed during thyroid surgery it should be repaired intraoperatively. The immediate repair has on balance more advantages than disadvantages and should be considered whenever possible. This should enable the maintenance of vocal cord tone, better and prompter voice recovery and avoidance of aspiration. Laryngoscope, 2020
- Organ preservation and oncological outcomes in early laryngeal cancer: a propensity score-based study(2021) CARVALHO, Genival Barbosa de; KOHLER, Hugo Fontan; MELLO, Julia Bette Homem de; LIRA, Renan Bezerra; PELLIZZON, Antonio Cassio de Assis; VARTANIAN, Jose Guilherme; KOWALSKI, Luiz PauloBackground. The rates of laryngeal preservation according to therapeutic modality in patients with initial laryngeal squamous cell carcinoma (LSCC) are still controversial. This study evaluated the rates of laryngeal preservation in patients who underwent treatment with surgery or radiotherapy. Methods. This retrospective cohort study evaluated 151 patients with stage I or II LSCC. Ninety-six patients were matched using a propensity-score and outcomes were compared within this group. Results. Regarding overall, cancer-specific survival and larynx preservation, no differences were observed according to the therapeutic modalities, but patients who underwent radiotherapy had a higher rate of local recurrence than those who underwent surgery. Patients classified as ASA 3 or 4 and treated with radiotherapy showed a tendency of higher risk of larynx loss. Conclusions. Patients with stage I or II laryngeal tumours can be submitted to surgery or radiotherapy with similar rates of laryngeal preservation.
- Current Trends and Controversies in the Management of Warthin Tumor of the Parotid Gland(2021) QUER, Miquel; HERNANDEZ-PRERA, Juan C.; SILVER, Carl E.; CASASAYAS, Maria; SIMO, Ricard; POORTEN, Vincent Vander; GUNTINAS-LICHIUS, Orlando; BRADLEY, Patrick J.; TONG-NG, Wai; RODRIGO, Juan P.; MAKITIE, Antti A.; RINALDO, Alessandra; KOWALSKI, Luiz P.; SANABRIA, Alvaro; BREE, Remco de; TAKES, Robert P.; LOPEZ, Fernando; OLSEN, Kerry D.; SHAHA, Ashok R.; FERLITO, AlfioPurpose: To review the current options in the management of Warthin tumors (WTs) and to propose a working management protocol. Methods: A systematic literature search was conducted using PubMed and ScienceDirect database. A total of 141 publications were selected and have been included in this review. Publications were selected based on relevance, scientific evidence, and actuality. Results: The importance of parotid WTs is increasing due to its rising incidence in many countries, becoming the most frequently encountered benign parotid tumor in certain parts of the world. In the past, all WTs were treated with surgery, but because of their slow growth rate, often minimal clinical symptoms, and the advanced age of many patients, active observation has gradually become more widely used. In order to decide on active surveillance, the diagnosis of WT must be reliable, and clinical, imaging, and cytological data should be concordant. There are four clear indications for upfront surgery: uncertain diagnosis; cosmetic problems; clinical complaints, such as pain, ulceration, or recurrent infection; and the patient's wish to have the tumor removed. In the remaining cases, surgery can be elective. Active surveillance is often suggested as the first approach, with surgery being considered if the tumor progresses and/or causes clinical complaints. The extent of surgery is another controversial topic, and the current trend is to minimize the resection using partial parotidectomies and extracapsular dissections when possible. Recently, non-surgical options such as microwave ablation, radiofrequency ablation, and ultrasound-guided ethanol sclerotherapy have been proposed for selected cases. Conclusions: The management of WT is gradually shifting from superficial or total parotidectomy to more conservative approaches, with more limited resections, and to active surveillance in an increasing number of patients. Additionally, non-surgical treatments are emerging, but their role needs to be defined in future studies.
- Tumor volume as a prognostic factor of locally advanced laryngeal cancer(2021) ANDRADE, Natalia Martins Magacho de; DEDIVITIS, Rogerio Aparecido; RAMOS, Daniel Marin; MATOS, Leandro Luongo; GARCIA, Marcio Ricardo Taveira; CONTI, Gustavo Goncalves; KOWALSKI, Luiz Paulo